Welcome to Saturday's Potluck

“Learn the rules like a pro, so you can break them like an artist.”
Pablo Picasso

Time passes quick it has been over a months since the last diary on Self Care. Observing and monitoring for changes in health is an important part of the practice. The tools range from simple observation and documenting paper to high tech applications for a smart phone. When using an application privacy of data varies with the vendor. If you are lucky enough to have a longterm relationship with a health provider who does this for you, be grateful. Majority of us have intermittent interaction.

These are the tools I use to establish baseline values. How often data is collected and the type will depend on health conditions and status. Unhurried calmness, patience to collect data consistently without judgement is a key factor in its usefulness. Most of the time it is boringly normal. If compared to my car the oil light has only come on twice in 40+ years of driving and one of those times it was important.

Bathroom scales - identify quick and gradual changes in weight. Daily checks for someone with congestive heart failure may identify an acute phase while it can still be treated without hospitalization.

Blood pressure cuff - like the wrist style to monitor for potential low and high pressure.

Thermometer - not everyone's normal is 98.6. Mild temperature increase can be a signal immune system has been activated.

Pulse oximeter - measuring blood oxygen can be purchased for less than 20 dollars. Easy way to know how much forest fire smoke or pollen is effecting breathing.

Blood glucose meters and strips - very low cost models are available without a prescription.

Personal experience with doctors and various family members is home home monitoring is appreciated when presented without pre-analysis. If offered with the statement "This shows I have a specific problem" doctor's mind immediately shift to ruling out the problem. If data is presented as "I noticed this change" or "This was odd, can you explain" doctor identifies the problem you suspected. Let them perform their specialty - diagnosing and ordering tests to confirm or rule out possibilities.

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Previous Open Threads related to Self Care.
Maintaining a private medical history
Finding basic information on medical conditions and medical diagnosis.
Finding basic information on drugs/medications.

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Obesity as a risk factor.

Normal-weight central obesity: Unique hazard of the toxic waist The Study.

Objective
To examine the mortality risk presented by normal-weight central obesity, to identify a clinical measure to aid in the identification of this phenotype, and to explore the means for mitigation of this risk.

Quality of evidence
Only prospective cohort studies (level II) comparing participants with central obesity at normal weight with those at higher levels of body mass index (BMI) were found. Good level I studies were available to demonstrate the effect of diet and exercise interventions on central obesity and mortality.

Main message
Participants with atherogenic dyslipidemia who are centrally obese at normal BMI are at similar, and possibly higher, mortality risk compared with those who are centrally obese and overweight or obese according to their BMI. Waist-to-height ratio might be the most pragmatic clinical measure of central obesity. The Mediterranean diet is an effective intervention to prevent ongoing weight gain while reducing abdominal girth. Low levels of exercise can also reduce waist circumference. Weight loss need not be an objective.
Conclusion

A waist-to-height ratio exceeding 0.5 at normal BMI identifies elevated mortality risk for cardiometabolic disease. This risk might equal or exceed that of centrally obese patients who are overweight or obese. Modest dietary and exercise interventions can be effective in mitigation of this risk.
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Conclusion
Visceral obesity is increasing faster in the North American population than generalized obesity is and it has a more profound effect on morbidity and mortality. The simplest and most valid measure of central obesity is WHtR. This phenotype is closely linked to atherogenic dyslipidemia, which predisposes one to the deposition of cholesterol in the vascular endothelium and resultant atherosclerosis. Individuals with normal-weight central obesity are at equivalent, and possibly higher, risk than people with central obesity who are overweight or obese by BMI.

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Government policy effects the number of hospital beds available to provide care for its citizens. The past 50 years the US has been decreasing the beds available to treat physical and mental health conditions. Current average number of beds for the country is 2.8 per 1000 people. Washington at 1.7 and Oregon at 1.6 rank as the bottom 2 states. (aprox 11:30 min) (originally aired over a year ago in April 2020 )

Check how many hospitals in your area were at risk of closing at the beginning of this year. 50% of Washington rural hospitals are at risk of closing and 35% for Oregon.

More than 500 rural hospitals in the U.S. were at immediate risk of closure before the COVID-19 pandemic because of financial losses and lack of reserves to maintain operations, according to a report from the Center for Healthcare Quality and Payment Reform.

Nearly every state had at least one rural hospital at immediate risk of closure before the pandemic. In 22 states, 25 percent or more of rural hospitals were at immediate risk, according to the report.

The hospitals identified as being at immediate risk of closure had a cumulative negative total margin over the most recent three-year period, and their financial situation has likely deteriorated because of the pandemic.

Across the U.S., more than 800 hospitals — 40 percent of all rural hospitals in the country — are either at immediate or high risk of closure. The more than 300 hospitals at high risk closure either have low financial reserves or high dependence on nonpatient service revenues such as local taxes or state subsidies, according to the report.

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The shift of elective surgeries from inpatient to outpatient procedures continues to be used to lower costs.

Total knee arthroplasty (TKA) was removed from the Centers for Medicare and Medicaid Services (CMS) Inpatient-Only (IPO) list starting January 1, 2018. Many hospitals responded by instructing surgeons to schedule all TKAs as outpatient procedures, and some local Medicare Advantage contractors began to expect outpatient status for all or most TKA cases.

When possible over the years I have preferred to arrange outpatient procedures for family members. There is a deceased risk of hospital acquired infections, a chemical restraint being used and drug induced dementia.

Current literature is now suggesting same day discharge for hip and knee surgery for high-risk patients.

Same-day discharge after total knee arthroplasty (TKA) or total hip arthroplasty (THA) is safe in some patients classified as "high risk"—with no increase in complications or other adverse outcomes, reports a study in The Journal of Bone & Joint Surgery.
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In both the THA and TKA groups, about one-third of patients were discharged on the same day as surgery, without spending a night in the hospital. Complication rates, emergency department (ED) visits, unplanned hospital readmissions, and mortality were compared for patients who underwent same-day or inpatient surgery.

For high-risk patients undergoing THA, same-day discharge was shown to be noninferior to inpatient surgery for most outcomes. At 90 days, same-day discharge showed no increase in complications, ED visits, or hospital readmissions. The study could not demonstrate noninferiority for mortality, as death was uncommon within 90-days post-discharge in both groups.

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What is on your mind today? (Responses to Covid questions and dialog to be conducted at The Dose diary)

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Comments

QMS's picture

Into one's own hands. We are being educated incrementally that the best advocate for our health
is no longer exclusively the medical establishment. Doc says "you need to be tested for X" and I go to find out what the parameters are. My crappy medicare insurance pays almost nothing towards these tests, and usually the specialist wants to see more tests. I'd rather forego the endless testing and not become another medical expense payee (brokee).

Just looking at the faces and i